24-MONTH OPT STEM EXTENSION EXAMPLE

This is an EXAMPLE document. Your answers will vary. Please carefully read each question

on the I-765 and answer in a way that matches your particular situation. Read the

“Instructions for Form I-765” for a more thorough explanation of this form:

https://www.uscis.gov/i-765

Leave the top portion of the form blank. Start with Part 1.

Type or print N/A (“not applicable”) if a question does not apply to you. For example, write N/A if you don’t have a middle name or if you’ve never used a name

other than your legal name.

Make sure to check the “Renewal” box

Your EAD card will be mailed to the address you put here. It

can be a residential address or a P.O. Box. Use an “In Care Of”

name if you plan to move in the next 2 to 4 months and you

would like a friend to receive your EAD card at their address.

The A-Number is the same as the USCIS Number on your EAD card.

Leave the USCIS Online Account Number blank

Select “Yes” and update part 6 of this form.

Select “Yes” if you’ve received a Social Security card in the past and “No” if you have not.

If you do not have a Social Security card, you can use this form to request to have one issued for you. Most students applying for the OPT STEM Extension, already have a Social Security card and can

skip to Item Number 18.a on this form.

Type or print the name of the country as it was named when you were born, even if the country’s name has changed or the

country no longer exists.

Go here to find your electronic I-94 record: https://i94.cbp.dhs.gov

Use the code (c)(3)(C) here.

If your full degree and major do not fit on the form, you may handwrite the information in

black ink or use Part 6 of the form to add more information.

If you are applying for the STEM extension based on a previously earned STEM degree (prior to your most recently earned degree) you must include additional evidence. See

Part 6 for an example.

YOU

MAY

SKIP

THIS

SECTION If you’ve ever had a different SEVIS number in the past, please make

sure to list it on Part 6 of this form.

YOU

MAY

SKIP

THIS

SECTION

Don’t forget to sign here in BLACK ink!

SKIP

YOU

MAY

SKIP

THIS

SECTION

YOU

MAY

SKIP

THIS

PAGE

THE SITUATIONS DESCRIBED BELOW MAY OR MAY NOT APPLY TO YOU.

IF THE SITUATION DOES APPLY TO YOU, PLEASE EDIT THE EXAMPLE TEXT TO SUIT YOUR NEEDS. MAKE SURE TO COPY THE PAGE NUMBER, PART NUMBER, AND ITEM NUMBER AS

SHOWN IN THE RELEVANT EXAMPLE.

If you answered “Yes” to Item Number 12 on page 2, you should list some information here about the previous time that you

applied for OPT and for which education level. You should attach your previous OPT

I-20s and your old EAD card.

(Even if the OPT request was denied, write that information here and attach a copy of the denial notice, if you have it.)

If you previously had an I-20 with a different SEVIS number, you should list that information here. You should also include

copies of the old I-20s with the different SEVIS number.

PREVIOUSLY EARNED DEGREE

In rare situations, a student may wish to apply for the OPT STEM Extension based on a previously earned STEM degree

(prior to the most recently earned degree). If this is the case, the I-765 instructions state that you must include “a copy of your prior STEM degree and evidence that the institution is

currently accredited by the U.S. Department of Education and certified by the SEVP.”

Database of U.S. Department of Education accredited institutions: https://studyinthestates.dhs.gov/school-search

The example above provides sample wording for this type of situation.